RCMG is committed to assisting network providers with process improvement support. The resources and forms on this page are among those most requested by our providers and are here for your convenience. Not all of these are created by RCMG and we are not responsible for the content on external sites and forms that you may find here. If you have suggestions for this page please feel free to mention them to your RCMG Provider Services Representative.

Forms:
Authorization form (paper version)
BC Member termination form
RCMG EFT form
Direct dermatology consent form
Direct dermatology image conversion
Case management form
Notice of pregnancy
Infant Nutrition, Therapeutic Formula Authorization form
RCMG member relations referral form
Social work referral form
CCS program eligibility (link leads to DHCS web site)
GeneDx test requisition form
Provider Dispute Resolution form (PDR)
Claim Settlement and Dispute Resolution Practices

HEDIS related:
PM160 FAQ
PM-160 Form
Guide for working the gaps in care report


Credentialing & New Provider Applications:

California participating physician application
California midlevel practitioner application
Provider information request form